Factors affecting the implementation of the Health Extension Workers Programme in Kavango East Region, Namibia

Background: The Namibian Health Extension Workers Programme (HEWP) plays a crucial role in ensuring equitable access to healthcare, particularly in rural areas. Little research exists on the factors affecting the implementation of HEWP; however, there is an urgent need for these services. Aim: To explore and describe the factors affecting the implementation of the HEWP in Rundu District, Kavango East Region, Namibia. Setting: The study was conducted at the five primary health care clinics in the Rundu District, Kavango East region of Namibia. Methods: An exploratory descriptive qualitative research design was employed. The population consisted of 28 health extension workers (HEWs). Data saturation was reached with 13 participants; two more participants were added, bringing the total to 15, and no new information emerged. Data were collected through semi-structured interviews using an audiotape recorder and field notes before being analysed thematically using Braun and Clarke's six steps of data analysis. Trustworthiness was ensured using Lincoln and Guba's four criteria. Ethical approval was obtained from the School of Nursing Research Committee, with the principles of beneficence, autonomy, justice and non-maleficence being adhered to. Results: Three prominent themes emerged: Organisational and resource-related factors affecting HEWP implementation; HEWs' capacity and engagement; and recommendations to ensure the effective implementation of the HEWP. Conclusion: The findings revealed that there are several barriers that need to be overcome before the desired outcome of HEWP can be successful. Major obstacles to programme implementation include insufficient resources, excessive staff turnover and inadequate training. Contribution: The results of this study can be used to develop targeted interventions and strategies to mitigate the factors encountered during the implementation of the HEWP in Namibia and similar settings.